senate Bill S5671A

Relates to the provision of services by long term home health care programs; repealer

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 03 / Jun / 2013
    • REFERRED TO HEALTH
  • 17 / Jun / 2013
    • AMEND AND RECOMMIT TO HEALTH
  • 17 / Jun / 2013
    • PRINT NUMBER 5671A
  • 08 / Jan / 2014
    • REFERRED TO HEALTH

Summary

Relates to the provision of services by long term home health care programs.

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Bill Details

See Assembly Version of this Bill:
A7922A
Versions:
S5671
S5671A
Legislative Cycle:
2013-2014
Current Committee:
Senate Health
Law Section:
Public Health Law
Laws Affected:
Amd §§3602, 4403-f & 3616, rpld §3610 sub 5 ¶(b), Pub Health L; amd §367-c, Soc Serv L

Sponsor Memo

BILL NUMBER:S5671A

TITLE OF BILL:
An act
to amend the public health law and the social services law, in relation
to the provision of services by long term home health care programs; and
to repeal certain provisions of the public health law relating thereto

PURPOSE OR GENERAL IDEA OF BILL:
To make conforming amendments to the long, term home health care plan
statute to further align the long term home health care plan to State
Medicaid redesign policies, so as to facilitate long term home health
care plan functionality, operation, and continuity under the state's
new policies.

SUMMARY OF SPECIFIC PROVISIONS:

Section one expresses the intent of the Legislature to further align
the long term home health care plan (LTHHCP) to function within the
evolving model of managed care.

Section two amends the eligibility for the LTHHCP to align it with
managed care plan eligibility.

Section two also amends the LTHHCP definition to make explicit its
ability to function as a contractor to a managed care plan.

Section three makes a conforming amendment to the Managed Long Term
Care (MLTC) statute to make explicit the ability of MLTCs to contract
with LTHHCP for LTHHCP services and to stipulate that the MLTC
statute (4403-0supersedes any inconsistent provisions between 4403-f
and article 36 for LTHHCP -services contracted to MLTC.

Sections 4 and 5 amend the social services law and public health law
provisions for authorization and provision of LTHHCP services. The
amendments stipulate that these respective provisions of law govern
LTHHCP except when LTHHCP services are provided and authorized under
MLTC, in which case, the MLTC statute governs.

Section 6 repeals provisions of article 36 that impose patient "slot"
limits on LTHHCPs.

Section 7 addresses the changing status of waivers for LTHHCP, further
reinforcing existing law to underscore that provision or operation of
LTHHCP is not contingent upon the authority to authorize
reimbursement for optional waivered services under a federal 1915(c)
waiver.

Section 8 establishes an immediate effective date for the bill.

JUSTIFICATIONof
:
New York State's Long Term Home Health Care ("Nursing Home Without
Walls") Program has been an integral part of the state's long term
care system for over three decades and is an important service option
for the state's citizens with chronic illness, infirmity, and


disability. The program provides quality care to long term care
patients at home at approximately half the cost of institutional care.

As the state shifts to a managed care structure for the delivery of
health services, this program should continue to fulfill its vital
role in the state's health care system. To effectively function in
the new system, however, certain changes are necessary to further
align this program to the evolving delivery structure.

This legislation provides for the series of conforming changes
necessary to facilitate LTHHCP functionality, operation, contracting,
and continuity in this evolving system.

These changes provide for sensibility and rationality of structure for
MLTC-LTHHCP contracting and partnering in the provision of care.

The legislation will promote achievement of the state's Medicaid
redesign goals, continuity of patient care, and continuity of the
LTHHCP as a vital component of the needed long term care
infrastructure.

PRIOR LEGISLATIVE HISTORY:
None.

FISCAL IMPLICATIONS:
This bill helps ensure efficiency and savings in the state Medicaid
program by facilitating the functionality, operation and contracting
of the LTHHCP within the evolving infrastructure. The LTHHCP has
provided a cost-effective alternative to institutionalization for 35
years, with patient care costs under the LTHHCP averaging
approximately 50 percent of nursing home costs.

EFFECTIVE DATE
:
The bill would take effect immediately.

view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 5671--A

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              June 3, 2013
                               ___________

Introduced  by  Sen. VALESKY -- read twice and ordered printed, and when
  printed to be committed  to  the  Committee  on  Health  --  committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee

AN  ACT  to  amend the public health law and the social services law, in
  relation to the provision of services by long term  home  health  care
  programs;  and  to  repeal certain provisions of the public health law
  relating thereto

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Legislative  intent.  The legislature finds that New York
State's Long Term  Home  Health  Care  ("Nursing  Home  Without  Walls")
Program  has for over three decades been an integral part of the state's
long term care system and an important service option  for  the  state's
citizens  with  chronic  illness,  infirmity and disability. The program
provides quality care to long term care patients at home at approximate-
ly half the cost of institutional care.
  As the state shifts to a managed care structure for  the  delivery  of
health services, the legislature finds that this program should continue
to fulfill its vital role in the state's health care system.  The legis-
lature  finds  however  that, to effectively function in the new system,
certain changes are necessary to  further  align  this  program  to  the
evolving  model  of  managed  care,  and concludes that these changes be
instituted simultaneously with managed care implementation.
  S 2. The opening paragraph of subdivision 8 of  section  3602  of  the
public  health  law,  as  amended by chapter 622 of the laws of 1988, is
amended and a new paragraph d is added to read as follows:
  "Long term home health care program" means a coordinated plan of  care
and  services  provided  at  home  to  (I)  invalid, infirm, or disabled
persons who are medically eligible for placement in a hospital or  resi-
dential  health  care  facility  for  an extended period of time if such

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11302-04-3

S. 5671--A                          2

program were unavailable, OR (II) PERSONS REQUIRING HOME AND  COMMUNITY-
BASED  SERVICES WHO ARE ENROLLED IN A MANAGED CARE PLAN AS DEFINED UNDER
PARAGRAPH (E) OF SUBDIVISION ONE OF  SECTION  THIRTY-SIX  HUNDRED  FOUR-
TEEN-C OF THIS ARTICLE.
  D. A LONG TERM HOME HEALTH CARE PROGRAM AS DEFINED IN THIS SUBDIVISION
AND  AUTHORIZED UNDER SECTION THIRTY-SIX HUNDRED TEN OF THIS ARTICLE MAY
BE PROVIDED (I) DIRECTLY, IN ACCORDANCE WITH SECTION THIRTY-SIX  HUNDRED
SIXTEEN OF THIS ARTICLE, OR (II) UNDER CONTRACT WITH A MANAGED CARE PLAN
AS  DEFINED UNDER PARAGRAPH (E) OF SUBDIVISION ONE OF SECTION THIRTY-SIX
HUNDRED FOURTEEN-C OF THIS ARTICLE.
  S 3. Subdivision 10 of section 4403-f of the  public  health  law,  as
amended  by section 41-b of part H of chapter 59 of the laws of 2011, is
amended to read as follows:
  10. Notwithstanding any inconsistent provision to  the  contrary,  the
enrollment  and  disenrollment process and services provided or arranged
by all operating demonstrations or any program that receives designation
as a Program of All-Inclusive Care for the Elderly (PACE) as  authorized
by  federal  public  law  105-33, subtitle I of title IV of the Balanced
Budget Act of 1997,  must  meet  all  applicable  federal  requirements.
Services may include, but need not be limited to, housing, inpatient and
outpatient hospital services, nursing home care, home health care, adult
day  care,  assisted living services provided in accordance with article
forty-six-B of this chapter,  adult  care  facility  services,  enriched
housing  program  services,  hospice  care, respite care, personal care,
homemaker services,  diagnostic  laboratory  services,  therapeutic  and
diagnostic  radiologic  services,  emergency  services,  emergency alarm
systems, home delivered meals,  physical  adaptations  to  the  client's
home,  physician  care  (including  consultant  and  referral services),
ancillary  services,  case  management  services,  transportation,   and
related  medical  services.    A  PLAN  MAY CONTRACT WITH LONG TERM HOME
HEALTH CARE PROGRAMS AUTHORIZED UNDER ARTICLE THIRTY-SIX OF THIS CHAPTER
OR HOME CARE AGENCIES CERTIFIED OR LICENSED PURSUANT TO SUCH ARTICLE FOR
THE PROVISION OF SERVICES, INCLUDING CASE MANAGEMENT SERVICES,  TO  PLAN
ENROLLEES;  PROVIDED  THAT  SUCH PROGRAMS OR AGENCIES SHALL PROVIDE SUCH
SERVICES CONSISTENT WITH THE PROVISIONS  OF  THIS  SECTION  WHICH  SHALL
SUPERSEDE  ANY  INCONSISTENT  PROVISIONS  OF  ARTICLE THIRTY-SIX OF THIS
CHAPTER OR THE REGULATIONS OF THE DEPARTMENT PROMULGATED THERETO.
  S 4. Subdivision 1 of section 367-c of the  social  services  law,  as
added by chapter 895 of the laws of 1977, is amended to read as follows:
  1.  EXCEPT  WHEN  LONG  TERM  HOME  HEALTH  CARE  PROGRAM SERVICES ARE
PROVIDED PURSUANT TO A CONTRACT WITH A PLAN APPROVED PURSUANT TO SECTION
FORTY-FOUR HUNDRED THREE-F OF THE PUBLIC HEALTH  LAW  OR  SECTION  THREE
HUNDRED  SIXTY-FOUR-J OF THIS TITLE, IN WHICH CASE LONG TERM HOME HEALTH
CARE PROGRAM SERVICES SHALL BE AUTHORIZED PURSUANT TO THE PROVISIONS  OF
SUCH  SECTIONS,  LONG  TERM  HOME  HEALTH CARE PROGRAM SERVICES SHALL BE
PROVIDED IN ACCORDANCE WITH THIS SECTION AND SECTION THIRTY-SIX  HUNDRED
SIXTEEN OF THE PUBLIC HEALTH LAW.
  If a long term home health care program as defined under article thir-
ty-six  of  the  public  health  law  is provided in the social services
district for which he has authority, the local social services official,
before he authorizes care in a nursing home or intermediate care facili-
ty for a person eligible to receive services  under  this  title,  shall
notify the person in writing of the provisions of this section.
  S  5.  Subdivision  1  of  section  3616  of the public health law, as
amended by chapter 622 of the laws  of  1988,  is  amended  to  read  as
follows:

S. 5671--A                          3

  1.  A  long  term home health care program shall be provided [only] to
those patients who REQUIRE HOME AND COMMUNITY BASED SERVICES,  INCLUDING
PERSONS  WHO are medically eligible for placement in a hospital or resi-
dential health care  facility.  An  AIDS  home  care  program  shall  be
provided  [only]  to  PERSONS  WHO  REQUIRE  HOME  AND  COMMUNITY  BASED
SERVICES, INCLUDING persons who are medically eligible for placement  in
a hospital or residential health care facility and who (a) are diagnosed
by a physician as having acquired immune deficiency syndrome, or (b) are
deemed  by  a  physician,  within  his judgment, to be infected with the
etiologic agent  of  acquired  immune  deficiency  syndrome,  and  whose
illness,  infirmity  or  disability  can be reasonably ascertained to be
associated with such infection.  EXCEPT WHEN LONG TERM HOME HEALTH  CARE
PROGRAM  SERVICES  ARE  PROVIDED  PURSUANT  TO  A  CONTRACT  WITH A PLAN
APPROVED PURSUANT TO SECTION FORTY-FOUR HUNDRED THREE-F OF THIS  CHAPTER
OR  SECTION  THREE  HUNDRED  SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW, IN
WHICH CASE LONG TERM HOME HEALTH CARE PROGRAM SERVICES SHALL BE  AUTHOR-
IZED  PURSUANT TO THE PROVISIONS OF SUCH SECTIONS, LONG TERM HOME HEALTH
CARE PROGRAM SERVICES SHALL BE PROVIDED IN ACCORDANCE WITH THIS SECTION.
Provision of certified home health agency services,  a  long  term  home
health  care program or an AIDS home care program paid for by government
funds shall be based upon, but not limited to, a  comprehensive  assess-
ment  that  shall  include,  but not be limited to, an evaluation of the
medical, social and environmental  needs  of  each  applicant  for  such
services  or  program. This assessment shall also serve as the basis for
the development and provision of an appropriate plan  of  care  for  the
applicant. In cases in which the applicant is a patient in a hospital or
residential  health  care facility, the assessment shall be completed by
persons designated by the commissioner, including, but not  limited  to,
the  applicant's physician, the discharge coordinator of the hospital or
residential health care facility referring the  applicant,  a  represen-
tative  of the local department of social services, and a representative
of the provider of a long term home health care program, AIDS home  care
program,  or the certified home health agency that will provide services
for the patient.  In cases in which the applicant is not a patient in  a
hospital  or  residential  health care facility, the assessment shall be
completed by persons designated by the commissioner including,  but  not
limited  to,  the  applicant's  physician, a representative of the local
department of social services and a representative of the provider of  a
long term home health care program, AIDS home care program or the certi-
fied  home health agency that will provide services for the patient. The
assessment shall be completed prior to or within thirty days  after  the
provision of services begins. Payment for services provided prior to the
completion  of  the  assessment  shall be made only if it is determined,
based upon such  assessment,  that  the  recipient  qualifies  for  such
services.  The  commissioner  shall  prescribe  the  forms  on which the
assessment will be made.
  S 6. Paragraph (b) of subdivision 5 of  section  3610  of  the  public
health law is REPEALED.
  S  7.  Subdivision  6  of section 367-c of the social services law, as
added by chapter 263 of the laws of 1979 and as  renumbered  by  chapter
854 of the laws of 1987, is amended to read as follows:
  6.  Notwithstanding  any  inconsistent provision of law but subject to
expenditure limitations of this section, the  commissioner,  subject  to
the  approval  of  the  state  director of the budget, may authorize the
utilization of medical assistance funds to pay for services provided  by
specified  long  term  home  health  care  programs in addition to those

S. 5671--A                          4

services included in the medical assistance program under section  three
hundred  sixty-five-a  of  this  chapter,  so  long as federal financial
participation is available for  such  services;  PROVIDED  HOWEVER  THAT
AUTHORIZATION  OF  MEDICAL ASSISTANCE FUNDS FOR SUCH ADDITIONAL SERVICES
PURSUANT TO A WAIVER UNDER SECTION NINETEEN  HUNDRED  FIFTEEN-C  OF  THE
FEDERAL SOCIAL SECURITY ACT SHALL NOT BE CONSTRUED AS REQUISITE FOR LONG
TERM  HOME  HEALTH CARE PROGRAM AUTHORIZATION OR OPERATION. Expenditures
made under this subdivision shall be deemed payments for medical assist-
ance for needy persons and shall be  subject  to  reimbursement  by  the
state  in accordance with the provisions of section three hundred sixty-
eight-a of this chapter.
  S 8. This act shall take effect immediately; provided that the  amend-
ments  to subdivision 10 of section 4403-f of the public health law made
by section three of this act shall not affect the repeal of such section
and shall be deemed repealed therewith.

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